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Andric V, Boban J, Maric D, Kozic D, Brkic S, Bulovic A. Additive Effect of Metabolic Syndrome on Brain Atrophy in People Living with HIV-Magnetic Resonance Volumetry Study. Metabolites 2024; 14:331. [PMID: 38921466 PMCID: PMC11205900 DOI: 10.3390/metabo14060331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 06/27/2024] Open
Abstract
With people living with HIV (PLWH) reaching the senium, the importance of aging-related comorbidities such as metabolic syndrome (MS) becomes increasingly important. This study aimed to determine the additive effect of MS on brain atrophy in PLWH. This prospective study included 43 PLWH, average age of 43.02 ± 10.93 years, and 24 healthy controls, average age of 36.87 ± 8.89 years. PLWH were divided into two subgroups: without MS and with MS, according to NCEP ATP III criteria. All patients underwent brain magnetic resonance imaging (MRI) on a 3T clinical scanner with MR volumetry, used for defining volumes of cerebrospinal fluid (CSF) spaces and white and grey matter structures, including basal ganglia. A Student's t-test was used to determine differences in brain volumes between subject subgroups. The binary classification was performed to determine the sensitivity and specificity of volumetry findings and cut-off values. Statistical significance was set at p < 0.05. PLWH presented with significantly lower volumes of gray matter, putamen, thalamus, globus pallidus, and nc. accumbens compared to healthy controls; cut-off values were: for gray matter 738.130 cm3, putamen 8.535 cm3, thalamus 11.895 cm3, globus pallidus 2.252 cm3, and nc. accumbens 0.715 cm3. The volumes of CSF and left lateral ventricles were found to be higher in PLWH with MS compared to those without MS, where, with a specificity of 0.310 and sensitivity of 0.714, it can be assumed that PLWH with a CSF volume exceeding 212.83 cm3 are likely to also have MS. This suggests that PLWH with metabolic syndrome may exhibit increased CSF volume above 212.83 cm3 as a consequence of brain atrophy. There seems to be an important connection between MS and brain volume reduction in PLWH with MS, which may add to the accurate identification of persons at risk of developing HIV-associated cognitive impairment.
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Affiliation(s)
- Vanja Andric
- Department for Infectious Diseases, Faculty of Medicine Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (J.B.); (D.M.); (D.K.); (S.B.); (A.B.)
- Clinic for Infectious Diseases, Clinical Center of Vojvodina, Hajduk Veljkova 1, 21000 Novi Sad, Serbia
| | - Jasmina Boban
- Department for Infectious Diseases, Faculty of Medicine Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (J.B.); (D.M.); (D.K.); (S.B.); (A.B.)
- Department for Radiology, Oncology Institute of Vojvodina, Put dr Goldmana 4, 21204 Sremska Kamenica, Serbia
| | - Daniela Maric
- Department for Infectious Diseases, Faculty of Medicine Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (J.B.); (D.M.); (D.K.); (S.B.); (A.B.)
- Clinic for Infectious Diseases, Clinical Center of Vojvodina, Hajduk Veljkova 1, 21000 Novi Sad, Serbia
| | - Dusko Kozic
- Department for Infectious Diseases, Faculty of Medicine Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (J.B.); (D.M.); (D.K.); (S.B.); (A.B.)
- Department for Radiology, Oncology Institute of Vojvodina, Put dr Goldmana 4, 21204 Sremska Kamenica, Serbia
| | - Snezana Brkic
- Department for Infectious Diseases, Faculty of Medicine Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (J.B.); (D.M.); (D.K.); (S.B.); (A.B.)
- Clinic for Infectious Diseases, Clinical Center of Vojvodina, Hajduk Veljkova 1, 21000 Novi Sad, Serbia
| | - Aleksandra Bulovic
- Department for Infectious Diseases, Faculty of Medicine Novi Sad, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (J.B.); (D.M.); (D.K.); (S.B.); (A.B.)
- Clinic for Infectious Diseases, Clinical Center of Vojvodina, Hajduk Veljkova 1, 21000 Novi Sad, Serbia
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dos Santos AP, da Silva LSL, Navarro AM, Cordeiro JFC, Marchiori GF, Abdalla PP, Tasinafo Júnior MF, Venturini ACR, Gomide EBG, Brilhadori J, Correia IM, Benedetti C, Mota J, Bohn L, Machado DRL. Forecasting and validating fat mass ratio models through anthropometric measurements and health-related factors among people with HIV: a cross-sectional investigation. ANNALS OF TRANSLATIONAL MEDICINE 2024; 12:44. [PMID: 38911564 PMCID: PMC11193570 DOI: 10.21037/atm-23-1946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/28/2024] [Indexed: 06/25/2024]
Abstract
Background There is a limited research on predictive models of fat mass ratio (FMR) in people living with human immunodeficiency virus (HIV) (PWH). This study aimed to develop models considering anthropometric and health-related factors to predict and validate FMR in PWH regardless of sex. Methods One hundred and six Brazilian PWH (46.4±9.8 years) were evaluated for body composition using dual-energy X-ray absorptiometry (DXA), body circumference (BC), and skinfold thicknesses (SKs). FMR predictive models were developed using stepwise linear regression, and their agreement with DXA was assessed using Bland-Altman plots. Cross-validation was performed using the predicted residual error sum of squares (PRESS) method. Results Six FMR estimation models were developed for PWH, with adjusted R2 ranging from 0.43 to 0.72, standard error of the estimate (SEE) from 0.16% to 0.22%, and 95% confidence interval (CI) from 1.03 to 1.15. Model 6, including thigh SK, waist BC, therapy duration, subscapular SK, education years, and abdominal SK, exhibited the highest determination power (R2 adjusted 0.72, SEE 0.16%, and 95% CI: 1.06-1.15). The agreement between DXA-based FMR and predictive models showed minimal bias (-0.03 to +0.04) and narrower limits of agreement, particularly for the top-performing model (-0.33 to +0.30). Model 6 exhibited a high adjusted Q2PRESS (0.70) and low SPRESS (0.17). Conclusions Our predictive models advance the study of body composition in PWH by consolidating the use of anthropometry for diagnosing and monitoring lipodystrophy regardless of sex.
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Affiliation(s)
- André Pereira dos Santos
- Faculty of Sport of the University of Porto, Porto, Portugal
- College of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Human Exposome and Infectious Diseases Network (HEID), University of São Paulo, Ribeirão Preto, Brazil
| | - Leonardo Santos Lopes da Silva
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | | | - Pedro Pugliesi Abdalla
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Márcio Fernando Tasinafo Júnior
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Ana Cláudia Rossini Venturini
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Euripedes Barsanulfo Gonçalves Gomide
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Claretiano - University Center, Batatais, São Paulo, Brazil
| | - Joana Brilhadori
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Igor Massari Correia
- College of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Caio Benedetti
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Jorge Mota
- Research Center in Physical Activity, Health and Leisure (CIAFEL) and Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, Porto, Portugal
| | - Lucimere Bohn
- Research Center in Physical Activity, Health and Leisure (CIAFEL) and Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, Porto, Portugal
- Research Center in Sport, Physical Education, and Exercise and Health (CIDEFES), Lusófona University, Porto, Portugal
| | - Dalmo Roberto Lopes Machado
- College of Nursing of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Study and Research Group in Anthropometry, Training and Sport, School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
- Research Center in Physical Activity, Health and Leisure (CIAFEL) and Laboratory for Integrative and Translational Research in Population Health (ITR), Faculty of Sports, University of Porto, Porto, Portugal
- School of Education and Communication (ESEC), University of Algarve, Penha Campus, Faro, Portugal
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Obare LM, Temu T, Mallal SA, Wanjalla CN. Inflammation in HIV and Its Impact on Atherosclerotic Cardiovascular Disease. Circ Res 2024; 134:1515-1545. [PMID: 38781301 PMCID: PMC11122788 DOI: 10.1161/circresaha.124.323891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
People living with HIV have a 1.5- to 2-fold increased risk of developing cardiovascular disease. Despite treatment with highly effective antiretroviral therapy, people living with HIV have chronic inflammation that makes them susceptible to multiple comorbidities. Several factors, including the HIV reservoir, coinfections, clonal hematopoiesis of indeterminate potential (CHIP), microbial translocation, and antiretroviral therapy, may contribute to the chronic state of inflammation. Within the innate immune system, macrophages harbor latent HIV and are among the prominent immune cells present in atheroma during the progression of atherosclerosis. They secrete inflammatory cytokines such as IL (interleukin)-6 and tumor necrosis-α that stimulate the expression of adhesion molecules on the endothelium. This leads to the recruitment of other immune cells, including cluster of differentiation (CD)8+ and CD4+ T cells, also present in early and late atheroma. As such, cells of the innate and adaptive immune systems contribute to both systemic inflammation and vascular inflammation. On a molecular level, HIV-1 primes the NLRP3 (NLR family pyrin domain containing 3) inflammasome, leading to an increased expression of IL-1β, which is important for cardiovascular outcomes. Moreover, activation of TLRs (toll-like receptors) by HIV, gut microbes, and substance abuse further activates the NLRP3 inflammasome pathway. Finally, HIV proteins such as Nef (negative regulatory factor) can inhibit cholesterol efflux in monocytes and macrophages through direct action on the cholesterol transporter ABCA1 (ATP-binding cassette transporter A1), which promotes the formation of foam cells and the progression of atherosclerotic plaque. Here, we summarize the stages of atherosclerosis in the context of HIV, highlighting the effects of HIV, coinfections, and antiretroviral therapy on cells of the innate and adaptive immune system and describe current and future interventions to reduce residual inflammation and improve cardiovascular outcomes among people living with HIV.
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Affiliation(s)
- Laventa M. Obare
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN (L.M.O., S.A.M., C.N.W.)
| | - Tecla Temu
- Department of Pathology, Harvard Medical School, Boston, MA (T.T.)
| | - Simon A. Mallal
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN (L.M.O., S.A.M., C.N.W.)
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN (S.A.M.)
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN (S.A.M.)
- Institute for Immunology and Infectious Diseases, Murdoch University, WA, Western Australia (S.A.M.)
| | - Celestine N. Wanjalla
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN (L.M.O., S.A.M., C.N.W.)
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Asgedom YS, Kebede TM, Gebrekidan AY, Koyira MM, Azeze GA, Lombebo AA, Efa AG, Haile KE, Kassie GA. Prevalence of metabolic syndrome among people living with human immunodeficiency virus in sub-Saharan Africa: a systematic review and meta-analysis. Sci Rep 2024; 14:11709. [PMID: 38777850 PMCID: PMC11111734 DOI: 10.1038/s41598-024-62497-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
Metabolic syndrome (MetS) poses a significant clinical challenge for individuals living with HIV (PLHIV). In sub-Saharan Africa (SSA), this condition is becoming a growing concern, owing to lifestyle changes and an increasingly aging population. Several SSA countries have reported on the prevalence of MetS. However, these estimates may be outdated because numerous recent studies have updated MetS prevalence among PLHIV in these countries. Moreover, prior research has focused on various study designs to report the pooled prevalence, which is a methodological limitation. Therefore, this systematic review and meta-analysis aimed to determine the pooled estimates of MetS in PLHIV in SSA by addressing these gaps. We systematically searched Google Scholar, Science Direct, Scopus, Web of Sciences, EMBASE, and PubMed/Medline for the prevalence of MetS and its subcomponents among people with HIV in sub-Saharan Africa. The estimated pooled prevalence was presented using a forest plot. Egger's and Begg's rank regression tests were used to assess evidence of publication bias. Twenty-five studies fulfilled the inclusion criteria after review of the updated PRISMA guidelines. The pooled prevalence of MetS was 21.01% [95% CI: (16.50, 25.51)] and 23.42% [95% CI: (19.16, 27.08)] to the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) and International Diabetes Federation (IDF) criteria, respectively. Low levels of high-density lipoprotein cholesterol (Low HDL) at 47.25% [95% CI: 34.17, 60.33)] were the highest reported individual subcomponent, followed by abdominal obesity at 38.44% [95% CI: (28.81, 48.88)]. The prevalence of MetS is high in sub-Saharan Africa. Low HDL levels and increased waist circumference/abdominal obesity were the most prevalent components of MetS. Therefore, early screening for MetS components and lifestyle modifications is required. Policymakers should develop strategies to prevent MetS before an epidemic occurs.PROSPERO: CRD42023445294.
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Kileel EM, Zheng A, Bor J, Fox MP, Crowther NJ, George JA, Khoza S, Rosen S, Venter WDF, Raal F, Hibberd P, Brennan AT. Does Engagement in HIV Care Affect Screening, Diagnosis, and Control of Noncommunicable Diseases in Sub-Saharan Africa? A Systematic Review and Meta-analysis. AIDS Behav 2024; 28:591-608. [PMID: 38300475 PMCID: PMC10876721 DOI: 10.1007/s10461-023-04248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2023] [Indexed: 02/02/2024]
Abstract
Low- and middle-income countries are facing a growing burden of noncommunicable diseases (NCDs). Providing HIV treatment may provide opportunities to increase access to NCD services in under-resourced environments. We conducted a systematic review and meta-analysis to evaluate whether use of antiretroviral therapy (ART) was associated with increased screening, diagnosis, treatment, and control of diabetes, hypertension, chronic kidney disease, or cardiovascular disease among people living with HIV in sub-Saharan Africa (SSA). A comprehensive search of electronic literature databases for studies published between 01 January 2011 and 31 December 2022 yielded 26 studies, describing 13,570 PLWH in SSA, 61% of whom were receiving ART. Random effects models were used to calculate summary odds ratios (ORs) of the risk of diagnosis by ART status and corresponding 95% confidence intervals (95% CIs), where appropriate. ART use was associated with a small but imprecise increase in the odds of diabetes diagnosis (OR 1.07; 95% CI 0.71, 1.60) and an increase in the odds of hypertension diagnosis (OR 2.10, 95% CI 1.42, 3.09). We found minimal data on the association between ART use and screening, treatment, or control of NCDs. Despite a potentially higher NCD risk among PLWH and regional efforts to integrate NCD and HIV care, evidence to support effective care integration models is lacking.
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Affiliation(s)
- Emma M Kileel
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA.
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | - Amy Zheng
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew P Fox
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel J Crowther
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jaya A George
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Siyabonga Khoza
- Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sydney Rosen
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Willem D F Venter
- Wits Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Public Health Medicine, School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Frederick Raal
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Patricia Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Alana T Brennan
- Department of Global Health, Boston University School of Public Health, Boston, MA, 02118, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Moyo-Chilufya M, Maluleke K, Kgarosi K, Muyoyeta M, Hongoro C, Musekiwa A. The burden of non-communicable diseases among people living with HIV in Sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2023; 65:102255. [PMID: 37842552 PMCID: PMC10570719 DOI: 10.1016/j.eclinm.2023.102255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
Background Non-communicable diseases (NCDs) are increasing among people living with HIV (PLHIV), especially in Sub-Saharan Africa (SSA). We determined the prevalence of NCDs and NCD risk factors among PLHIV in SSA to inform health policy makers. Methods We conducted a systematic review and meta-analysis on the prevalence of NCDs and risk factors among PLHIV in SSA. We comprehensively searched PubMed/MEDLINE, Scopus, and EBSCOhost (CINAHL) electronic databases for sources published from 2010 to July 2023. We applied the random effects meta-analysis model to pool the results using STATA. The systematic review protocol was registered on PROSPERO (registration number: CRD42021258769). Findings We included 188 studies from 21 countries in this meta-analysis. Our findings indicate pooled prevalence estimates for hypertension (20.1% [95% CI:17.5-22.7]), depression (30.4% [25.3-35.4]), diabetes (5.4% [4.4-6.4]), cervical cancer (1.5% [0.1-2.9]), chronic respiratory diseases (7.1% [4.0-10.3]), overweight/obesity (32.2% [29.7-34.7]), hypercholesterolemia (21.3% [16.6-26.0]), metabolic syndrome (23.9% [19.5-28.7]), alcohol consumption (21.3% [17.9-24.6]), and smoking (6.4% [5.2-7.7]). Interpretation People living with HIV have a high prevalence of NCDs and their risk factors including hypertension, depression, overweight/obesity, hypercholesterolemia, metabolic syndrome and alcohol consumption. We recommend strengthening of health systems to allow for improved integration of NCDs and HIV services in public health facilities in SSA. NCD risk factors such as obesity, hypercholesterolemia, and alcohol consumption can be addressed through health promotion campaigns. There is a need for further research on the burden of NCDs among PLHIV in most of SSA. Funding This study did not receive any funding.
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Affiliation(s)
- Maureen Moyo-Chilufya
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Kuhlula Maluleke
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Kabelo Kgarosi
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Charles Hongoro
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- Human Sciences Research Council, Pretoria, South Africa
| | - Alfred Musekiwa
- Faculty of Health Sciences, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Abera W, Wube TB, Alemayehu T. The association of aspartate transaminase-to-alanine transaminase ratio and metabolic syndrome among HIV patients in Sidama Region, South Ethiopia. SAGE Open Med 2023; 11:20503121231196701. [PMID: 37694128 PMCID: PMC10483979 DOI: 10.1177/20503121231196701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Objective Studies on the association of the aspartate transaminase-to-alanine transaminase ratio with the metabolic syndrome and its components among HIV patients were scarce. This study aims to determine the association between the aspartate transaminase-to-alanine transaminase ratio and the metabolic syndrome and its components in adult HIV patients on highly active antiretroviral therapy. Methods This was a cross-sectional study conducted on 302 HIV patients from January 15 to June 30, 2021. Sociodemographic, clinical, and anthropometric data were collected using a structured questionnaire. The patient's medical records were reviewed. Biochemical analysis was performed after 5 ml of venous blood was collected from each study participant. Metabolic syndrome was defined by the third report of the national cholesterol education program-adult treatment panel. Logistic regression was done to assess the association of MetS with the independent variables, and correlation analysis was performed to see the correlation of MetS components with the aspartate aminotransferase-to-alanine aminotransferase ratio. Result 302 HIV-positive patients on highly active antiretroviral therapy were included in this study, and 54.6% were female. The median and interquartile range of the age of the study participants were 41 (35-50) years. The prevalence of metabolic syndrome was 29.5% (confidence interval = 24.5-35.1). Chronic illness (Adjusted odds ratio = 4.8, confidence interval = 2.2-10.9) and aspartate aminotransferase-to-alanine aminotransferase ratio (adjusted odds ratio = 2.5, confidence interval = 1.4-4.4) were significantly associated with Metabolic syndrome among the study participants. The aspartate aminotransferase-to-alanine aminotransferase ratio was significantly correlated with blood pressure. Conclusion This study found the existence of a significant association between the aspartate aminotransferase-to-alanine aminotransferase ratio and metabolic syndrome among HIV patients.
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Affiliation(s)
- Wondwossen Abera
- School of Medical Laboratory Science, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Temesgen Bizuayehu Wube
- School of Medical Laboratory Science, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Tsegaye Alemayehu
- School of Medical Laboratory Science, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
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Bowo-Ngandji A, Kenmoe S, Ebogo-Belobo JT, Kenfack-Momo R, Takuissu GR, Kengne-Ndé C, Mbaga DS, Tchatchouang S, Kenfack-Zanguim J, Lontuo Fogang R, Zeuko'o Menkem E, Ndzie Ondigui JL, Kame-Ngasse GI, Magoudjou-Pekam JN, Wandji Nguedjo M, Assam Assam JP, Enyegue Mandob D, Ngondi JL. Prevalence of the metabolic syndrome in African populations: A systematic review and meta-analysis. PLoS One 2023; 18:e0289155. [PMID: 37498832 PMCID: PMC10374159 DOI: 10.1371/journal.pone.0289155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The metabolic syndrome (MS) is a leading cause of death worldwide. Several studies have found MS to be prevalent in various African regions. However, no specific estimates of MS prevalence in African populations exist. The aim of this study was to estimate the overall prevalence of MS in the African populations. METHODS A systematic review was conducted in PubMed, Web of Science, Africa Index Medicus, and African Journal Online Scopus to find studies published up to the 15th of August 2022. Pooled prevalence was calculated based on six diagnostic methods. The pooled prevalence of MS was estimated using a random-effects model. Our risk of bias analysis was based on the Hoy et al. tool. A Heterogeneity (I2) assessment was performed, as well as an Egger test for publication bias. PROSPERO number CRD42021275176 was assigned to this study. RESULTS In total, 297 studies corresponding to 345 prevalence data from 29 African countries and involving 156 464 participants were included. The overall prevalence of MS in Africa was 32.4% (95% CI: 30.2-34.7) with significant heterogeneity (I2 = 98.9%; P<0.001). We obtained prevalence rates of 44.8% (95% CI: 24.8-65.7), 39.7% (95% CI: 31.7-48.1), 33.1% (95% CI: 28.5-37.8), 31.6% (95% CI: 27.8-35.6) and 29.3% (95% CI: 25.7-33) using the WHO, revised NCEP-ATP III, JIS, NCEP/ATP III and IDF definition criteria, respectively. The prevalence of MS was significantly higher in adults >18 years with 33.1% (95%CI: 30.8-35.5) compared to children <18 years with 13.3% (95%CI: 7.3-20.6) (P<0.001). MS prevalence was significantly higher in females with 36.9% (95%CI: 33.2-40.7) compared to males with 26.7% (95%CI: 23.1-30.5) (P<0.001). The prevalence of MS was highest among Type 2 diabetes patients with 66.9% (95%CI: 60.3-73.1), followed by patients with coronary artery disease with 55.2% (95%CI: 50.8-59.6) and cardiovascular diseases with 48.3% (95%CI: 33.5-63.3) (P<0.001). With 33.6% (95% CI: 28.3-39.1), the southern African region was the most affected, followed by upper-middle income economies with 35% (95% CI: 29.5-40.6). CONCLUSION This study, regardless of the definition used, reveals a high prevalence of MS in Africa, confirming the ongoing epidemiological transition in African countries. Early prevention and treatment strategies are urgently needed to reverse this trend.
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Affiliation(s)
- Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | - Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Institute of Medical Research and Medicinal Plants Studies, Medical Research Centre, Yaounde, Cameroon
| | - Raoul Kenfack-Momo
- Department of Biochemistry, The University of Yaounde I, Yaounde, Cameroon
| | - Guy Roussel Takuissu
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Cyprien Kengne-Ndé
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Douala, Cameroon
| | | | | | | | | | | | | | - Ginette Irma Kame-Ngasse
- Institute of Medical Research and Medicinal Plants Studies, Medical Research Centre, Yaounde, Cameroon
| | | | - Maxwell Wandji Nguedjo
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
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Peer N, Nguyen KA, Hill J, Sumner AE, Cikomola JC, Nachega JB, Kengne A. Prevalence and influences of diabetes and prediabetes among adults living with HIV in Africa: a systematic review and meta-analysis. J Int AIDS Soc 2023; 26:e26059. [PMID: 36924213 PMCID: PMC10018386 DOI: 10.1002/jia2.26059] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/11/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION In people living with human immunodeficiency virus (PLHIV), traditional cardiovascular risk factors, exposure to HIV per se and antiretroviral therapy (ART) are assumed to contribute to cardiometabolic diseases. Nevertheless, controversy exists on the relationship of HIV and ART with diabetes. To clarify the relationship between HIV and type 2 diabetes, this review determined, in PLHIV in Africa, diabetes and prediabetes prevalence, and the extent to which their relationship was modified by socio-demographic characteristics, body mass index (BMI), diagnostic definitions used for diabetes and prediabetes, and HIV-related characteristics, including CD4 count, and use and duration of ART. METHODS For this systematic review and meta-analysis (PROSPERO registration CRD42021231547), a comprehensive search of major databases (PubMed-MEDLINE, Scopus, Web of Science, Google Scholar and WHO Global Health Library) was conducted. Original research articles published between 2000 and 2021 in English and French were included, irrespective of study design, data collection techniques and diagnostic definitions used. Observational studies comprising at least 30 PLHIV and reporting on diabetes and/or prediabetes prevalence in Africa were included. Study-specific estimates were pooled using random effects models to generate the overall prevalence for each diagnostic definition. Data analyses used R statistical software and "meta" package. RESULTS Of the 2614 records initially screened, 366 full-text articles were assessed for eligibility and 61 were selected. In the systematic review, all studies were cross-sectional by design and clinic-based, except for five population-based studies. Across studies included in the meta-analysis, the proportion of men was 16-84%. Mean/median age was 30-62 years. Among 86,412 and 7976 participants, diabetes and prediabetes prevalence rates were 5.1% (95% CI: 4.3-5.9) and 15.1% (9.7-21.5). Self-reported diabetes (3.5%) was lower than when combined with biochemical assessments (6.2%; 7.2%). DISCUSSION While not statistically significant, diabetes and prediabetes were higher with greater BMI, in older participants, urban residents and more recent publications. Diabetes and prediabetes were not significantly different by HIV-related factors, including CD4 count and ART. CONCLUSIONS Although HIV-related factors did not modify prevalence, the diabetes burden in African PLHIV was considerable with suboptimal detection, and likely influenced by traditional risk factors. Furthermore, high prediabetes prevalence foreshadows substantial increases in future diabetes in African PLHIV.
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Affiliation(s)
- Nasheeta Peer
- Non‐communicable Diseases Research UnitSouth African Medical Research CouncilDurban and Cape TownSouth Africa
- Department of MedicineUniversity of Cape TownCape TownSouth Africa
| | - Kim Anh Nguyen
- Non‐communicable Diseases Research UnitSouth African Medical Research CouncilDurban and Cape TownSouth Africa
| | - Jillian Hill
- Non‐communicable Diseases Research UnitSouth African Medical Research CouncilDurban and Cape TownSouth Africa
| | - Anne E. Sumner
- Section on Ethnicity and HealthDiabetesEndocrinologyand Obesity BranchNational Institute of Diabetes and Digestive and Kidney DiseasesNational Institute of HealthBethesdaMarylandUSA
- National Institute on Minority Health and Health DisparitiesNational Institutes of HealthBethesdaMarylandUSA
| | - Justin Cirhuza Cikomola
- Faculty of MedicineUniversité Catholique de BukavuBukavuthe Democratic Republic of the Congo
| | - Jean Bisimwa Nachega
- Division of Infectious DiseasesDepartment of MedicineStellenbosch University Faculty of Medicine and Health SciencesCape TownSouth Africa
- Department of EpidemiologyInfectious Diseasesand Microbiologyand Center for Global HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of International HealthBloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Andre‐Pascal Kengne
- Non‐communicable Diseases Research UnitSouth African Medical Research CouncilDurban and Cape TownSouth Africa
- Department of MedicineUniversity of Cape TownCape TownSouth Africa
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Chihota BV, Mandiriri A, Shamu T, Muula G, Nyamutowa H, Taderera C, Mwamba D, Chilengi R, Bolton‐Moore C, Bosomprah S, Egger M, Chimbetete C, Wandeler G. Metabolic syndrome among treatment-naïve people living with and without HIV in Zambia and Zimbabwe: a cross-sectional analysis. J Int AIDS Soc 2022; 25:e26047. [PMID: 36522287 PMCID: PMC9755006 DOI: 10.1002/jia2.26047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Chronic viral replication has been linked to an increased risk of cardiovascular and metabolic diseases in people living with HIV (PLWH), but few studies have evaluated this association in Southern Africa. We explored the determinants of metabolic syndrome (MetS) among treatment-naïve adults living with and without HIV in Southern Africa. METHODS Treatment-naïve PLWH and people living without HIV (PLWOH) ≥30 years were consecutively enrolled from primary care clinics in Zambia and Zimbabwe. PLWOH were seronegative partners or persons presenting for HIV testing. We defined MetS as the presence of central obesity plus any two of the following: raised blood pressure, impaired fasting glucose, reduced high-density lipoprotein cholesterol and raised triglycerides, as defined by the International Diabetes Federation. We used logistic regression to determine factors associated with MetS. RESULTS Between August 2019 and March 2022, we screened 1285 adults and enrolled 420 (47%) PLWH and 481 (53%) PLWOH. The median age was similar between PLWH and PLWOH (40 vs. 38 years, p < 0.24). In PLWH, the median CD4+ count was 228 cells/mm3 (IQR 108-412) and the viral load was 24,114 copies/ml (IQR 277-214,271). Central obesity was present in 365/523 (70%) females and 57/378 males (15%). MetS was diagnosed in 172/901 (19%, 95% confidence interval [CI] 17-22%), and prevalence was higher among females than males (27% vs. 9%). In multivariable analyses, HIV status was not associated with MetS (adjusted odds ratio [aOR] 1.05, 95% CI 0.74-1.51). Risk factors for MetS included age older than 50 years (aOR 2.31, 95% CI 1.49-3.59), female sex (aOR 3.47, 95% CI 2.15-5.60), highest income (aOR 2.19, 95% CI 1.39-3.44) and less than World Health Organization recommended weekly physical activity (aOR 3.35, 95% CI 1.41-7.96). CONCLUSIONS We report a high prevalence of MetS and central obesity among females in urban Zambia and Zimbabwe. Lifestyle factors and older age appear to be the strongest predictors of MetS in our population, with no evident difference in MetS prevalence between treatment-naïve PLWH and PLWOH.
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Affiliation(s)
- Belinda V. Chihota
- Centre for Infectious Disease ResearchLusakaZambia,Graduate School of Health SciencesUniversity of BernBernSwitzerland,Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | | | - Tinei Shamu
- Graduate School of Health SciencesUniversity of BernBernSwitzerland,Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland,Newlands ClinicHarareZimbabwe
| | - Guy Muula
- Centre for Infectious Disease ResearchLusakaZambia
| | | | | | | | | | - Carolyn Bolton‐Moore
- Centre for Infectious Disease ResearchLusakaZambia,Department of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Samuel Bosomprah
- Centre for Infectious Disease ResearchLusakaZambia,Department of BiostatisticsSchool of Public HealthUniversity of GhanaAccraGhana
| | - Matthias Egger
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland,Centre for Infectious Disease Epidemiology and ResearchUniversity of Cape TownCape TownSouth Africa,Population Health SciencesBristol Medical School, University of BristolBristolUnited Kingdom
| | | | - Gilles Wandeler
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland,Department of Infectious DiseasesBern University HospitalUniversity of BernBernSwitzerland
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11
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Woldeyes E, Fisseha H, Mulatu HA, Ephrem A, Benti H, Alem MW, Ahmed AI. Prevalence of Clinical Cardiovascular Disease Risk Factors Among HIV Infected Patients on Anti-Retroviral Treatment in a Tertiary Hospital in Ethiopia. HIV AIDS (Auckl) 2022; 14:297-309. [PMID: 35747268 PMCID: PMC9211102 DOI: 10.2147/hiv.s362459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Anti-retroviral treatment has improved mortality of human immunodeficiency virus (HIV) infected patients, which is offset by an increasing burden of cardiovascular diseases (CVD). Data regarding prevalence of cardiovascular disease risk factors in HIV infected patients in Ethiopia are very scarce. The aim of this study was to determine the prevalence of CVD risks and associated factors in patients with HIV. Methods A cross-sectional study was conducted on 333 patients with HIV infection, using a modified World Health Organization’s stepwise approach to surveillance questionnaire. Anthropometric and blood pressure measurement was done along with biochemical studies. Cardiovascular risk was estimated using Framingham risk score. Multivariate logistic regression was used to examine the association between cardiovascular risks and associated factors, with a p-value of <0.05 considered statistically significant. Results The mean age of the participants was 45 years, and 69.2% were females. Most (80.9%) of the participants had viral load below 50 copies/mL and the mean CD4 count was 579 cells/mm3. Dyslipidemia was the most common risk factor identified in 69.4%, followed by abnormal fasting blood glucose (≥100 mg/dL) in 36.8%. Hypertension was diagnosed in 23.8%, while 22.8% and 11.1% had metabolic syndrome and obesity, respectively. Framingham risk score was low in 95.9%. Male gender, increasing age, high body mass index and previous ART regimen being tenofovir disoproxil fumarate, lamivudine and nevirapine increased CVD risk factors. Conclusion Traditional cardiovascular risk factors were high in the population studied. There is a need to raise awareness about the risk factors, and patients should have timely follow-up and care.
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Affiliation(s)
- Esubalew Woldeyes
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Correspondence: Esubalew Woldeyes, Email
| | - Henok Fisseha
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Hailu Abera Mulatu
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Abiy Ephrem
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Henok Benti
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mehari Wale Alem
- Department of Neurosurgery, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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12
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Nosik M, Ryzhov K, Rymanova I, Sobkin A, Kravtchenko A, Kuimova U, Pokrovsky V, Zverev V, Svitich O. Dynamics of Plasmatic Levels of Pro- and Anti-Inflammatory Cytokines in HIV-Infected Individuals with M. tuberculosis Co-Infection. Microorganisms 2021; 9:microorganisms9112291. [PMID: 34835417 PMCID: PMC8624412 DOI: 10.3390/microorganisms9112291] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/24/2021] [Accepted: 11/02/2021] [Indexed: 12/27/2022] Open
Abstract
Tuberculosis (TB) and HIV have profound effects on the immune system, which can lead to the activation of viral replication and negatively regulate the activation of T cells. Dysregulation in the production of cytokines necessary to fight HIV and M. tuberculosis may ultimately affect the results of the treatment and be important in the pathogenesis of HIV infection and TB. This work presents the results of a study of the expression of pro- and anti-inflammatory cytokines (IFN-γ, TNF-α, IL-2, IL-4, IL-6, IL-10, IL-1RA) in drug-naïve patients with dual infection of HIV/TB at the late stages of HIV-infection, with newly diagnosed HIV and TB, and previously untreated HIV in the process of receiving antiretroviral (ART) and TB treatment vs. a cohort of patients with HIV monoinfection and TB monoinfection. The study revealed that during a double HIV/TB infection, both Th1 and Th2 immune responses are suppressed, and a prolonged dysregulation of the immune response and an increased severity of the disease in pulmonary/extrapulmonary tuberculosis is observed in HIV/TB co-infection. Moreover, it was revealed that a double HIV/TB infection is characterized by delayed and incomplete recovery of immune activity. High levels of IL-6 were detected in patients with HIV/TB co-infection before initiation of dual therapy (2.1-fold increase vs. HIV), which persisted even after 6 months of treatment (8.96-fold increase vs. HIV), unlike other cytokines. The persistent enhanced expression of IL-6 in patients with dual HIV/TB co-infection allows the consideration of it as a potential marker of early detection of M. tuberculosis infection in HIV-infected individuals. The results of multivariate regression analysis showed a statistical trend towards an increase in the incidence of IRIS in patients with high IL-1Ra levels (in the range of 1550–2500 pg/mL): OR = 4.3 (95%CI 3.7–14.12, p = 0.53), which also allows IL-1Ra to be considered as a potential predictive biomarker of the development of TB-IRIS and treatment outcomes.
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Affiliation(s)
- Marina Nosik
- I.I. Mechnikov Institute of Vaccine and Sera, 105064 Moscow, Russia; (K.R.); (V.Z.); (O.S.)
- Correspondence:
| | - Konstantin Ryzhov
- I.I. Mechnikov Institute of Vaccine and Sera, 105064 Moscow, Russia; (K.R.); (V.Z.); (O.S.)
| | - Irina Rymanova
- G.A. Zaharyan Moscow Tuberculosis Clinic, Department for Treatment of TB Patients with HIV Infection, 125466 Moscow, Russia; (I.R.); (A.S.)
| | - Alexandr Sobkin
- G.A. Zaharyan Moscow Tuberculosis Clinic, Department for Treatment of TB Patients with HIV Infection, 125466 Moscow, Russia; (I.R.); (A.S.)
| | - Alexey Kravtchenko
- Central Research Institute of Epidemiology, 111123 Moscow, Russia; (A.K.); (U.K.); (V.P.)
| | - Ulyana Kuimova
- Central Research Institute of Epidemiology, 111123 Moscow, Russia; (A.K.); (U.K.); (V.P.)
| | - Vadim Pokrovsky
- Central Research Institute of Epidemiology, 111123 Moscow, Russia; (A.K.); (U.K.); (V.P.)
| | - Vitaly Zverev
- I.I. Mechnikov Institute of Vaccine and Sera, 105064 Moscow, Russia; (K.R.); (V.Z.); (O.S.)
| | - Oxana Svitich
- I.I. Mechnikov Institute of Vaccine and Sera, 105064 Moscow, Russia; (K.R.); (V.Z.); (O.S.)
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13
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Hamooya BM, Mulenga LB, Masenga SK, Fwemba I, Chirwa L, Siwingwa M, Halwiindi H, Koethe JR, Lipworth L, Heimburger DC, Musonda P, Mutale W. Metabolic syndrome in Zambian adults with human immunodeficiency virus on antiretroviral therapy: Prevalence and associated factors. Medicine (Baltimore) 2021; 100:e25236. [PMID: 33832083 PMCID: PMC8036111 DOI: 10.1097/md.0000000000025236] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/25/2021] [Indexed: 01/05/2023] Open
Abstract
Metabolic syndrome (MetS) is a constellation of factors including hypertension, abdominal obesity, dyslipidemia, and insulin resistance that separately and together significantly increase risk for cardiovascular disease (CVD) and diabetes. In sub-Saharan Africa, with a substantial burden of human immunodeficiency virus (HIV) and increasing prevalence of CVD and diabetes, there is a paucity of epidemiological data on demographic, laboratory, and clinical characteristics associated with MetS among people with HIV (people with human [PWH]). Therefore, this study aimed to determine the burden and factors influencing MetS in antiretroviral therapy (ART)-experienced individuals in Zambia.We collected cross-sectional demographic, lifestyle, anthropometric, clinical, and laboratory data in a cohort of ART-experienced (on ART for ≥6 months) adults in 24 urban HIV treatment clinics of Zambia between August, 2016 and May, 2020. MetS was defined as having ≥3 of the following characteristics: low high density lipoprotein cholesterol (HDL-c) (<1.0 mmol/L for men, <1.3 for women), elevated waist circumference (≥94 cm for men, ≥80 cm for women), elevated triglycerides (≥1.7 mmol/L), elevated fasting blood glucose (≥5.6 mmol/L), and elevated blood pressure (BP) (systolic BP ≥130 or diastolic BP ≥85 mm Hg). Virological failure (VF) was defined as HIV viral load ≥1000 copies/mL. The following statistical methods were used: Chi-square test, Wilcoxon rank-sum test, and multivariable logistic regression.Among 1108 participants, the median age (interquartile range [IQR]) was 41 years (34, 49); 666 (60.1%) were females. The prevalence of MetS was 26.3% (95% confidence interval [CI] 23.9-29.1). Age (adjusted odds ratio [OR] 1.07; 95% CI 1.04-1.11), female sex (OR 3.02; 95% CI 1.55-5.91), VF (OR 1.98; 95% CI 1.01-3.87), dolutegravir (DTG)-based regimen (OR 2.10; 95% CI 1.05-4.20), hip-circumference (OR 1.03; 95% CI 1.01-1.05), T-lymphocyte count (OR 2.23; 95% CI 1.44-3.43), high-sensitivity C-reactive protein (hsCRP) (OR 1.14; 95% CI 1.01-1.29), and fasting insulin (OR 1.02; 95% CI 1.01-1.04) were significantly associated with MetS.Metabolic syndrome was highly prevalent among HIV+ adults receiving ART in Zambia and associated with demographic, clinical, anthropometric, and inflammatory characteristics. The association between MetS and dolutegravir requires further investigation, as does elucidation of the impact of MetS on ART outcomes in sub-Saharan African PWH.
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Affiliation(s)
- Benson M. Hamooya
- University of Zambia School of Public Health
- Mulungushi University School of Medicine and Health Sciences, Livingstone
- Vanderbilt Institute for Global Health
| | - Lloyd B. Mulenga
- Ministry of Health
- University of Zambia School of Medicine, Lusaka, Zambia
- University Teaching Hospital, Adult Infectious Disease Center, Zambia
| | - Sepiso K. Masenga
- Mulungushi University School of Medicine and Health Sciences, Livingstone
- Vanderbilt Institute for Global Health
- Department of Biomedical Sciences, University of Zambia School of Health Sciences, Lusaka
| | | | - Lameck Chirwa
- University Teaching Hospital, Adult Infectious Disease Center, Zambia
| | - Mpanji Siwingwa
- University Teaching Hospital, Adult Infectious Disease Center, Zambia
| | | | - John R. Koethe
- Vanderbilt Institute for Global Health
- Vanderbilt University Medical Center Nashville, Tennessee
| | - Loren Lipworth
- Vanderbilt University Medical Center Nashville, Tennessee
| | - Douglas C. Heimburger
- Vanderbilt Institute for Global Health
- University of Zambia School of Medicine, Lusaka, Zambia
- Vanderbilt University Medical Center Nashville, Tennessee
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14
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Tilahun H, Masyuko SJ, Mogaka JN, Temu T, Kinuthia J, Osoti AO, Nakanjako D, Farquhar C, Page ST. Prevalence and correlates of dyslipidemia in HIV positive and negative adults in Western Kenya: A cross-sectional study. Medicine (Baltimore) 2021; 100:e24800. [PMID: 33725834 PMCID: PMC7969311 DOI: 10.1097/md.0000000000024800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/01/2021] [Accepted: 01/28/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT There is increasing morbidity and mortality from cardiovascular diseases (CVD) in sub-Saharan Africa (SSA). Dyslipidemia is a well-known CVD risk factor which has been associated with human immunodeficiency virus (HIV) infection and its treatment in high-income countries. Studies in SSA that have examined the relationship between HIV and dyslipidemia have reported mixed results. In this study, we sought to determine the prevalence of dyslipidemia in HIV positive and negative adults (>=30 years old) and evaluate for association in Western Kenya with a higher prevalence expected among HIV positive individuals.HIV positive adults receiving antiretroviral therapy (ART) and HIV negative individuals seeking HIV testing and counseling services were recruited into a cross-sectional study. Demographic and behavioral data and fasting blood samples were collected. Dyslipidemia was defined according to the National Cholesterol Education Program Adult Treatment Panel III. Associations between baseline demographic and clinical variables and dyslipidemia were analyzed using logistic regression.A total of 598 participants, 300 HIV positive and 298 HIV negative adults were enrolled. Dyslipidemia data was available for 564 (94%) participants. In total, 267 (47%) had dyslipidemia. This was not significantly different between HIV positive and HIV negative individuals (46% vs 49%, P = .4). In a multivariate analysis including both HIV positive and negative individuals, adults 50 to 59 years of age had a 2-fold increased risk of dyslipidemia (Odds ratio [OR] 2.1, 95% confidence interval (1.2-3.5) when compared to 30 to 39-years-old participants. Abdominal obesity (OR 2.5), being overweight (OR 1.9), and low fruit and vegetable intake (OR 2.2) were significantly associated with dyslipidemia. Among HIV positive participants, time since HIV diagnosis, ART duration, use of (PI) protease inhibitor-based ART, viral load suppression, current cluster of differentiation (CD4) count and nadir CD4 did not have significant associations with dyslipidemia.The prevalence of dyslipidemia is high in Western Kenya, with nearly half of all participants with lipid abnormalities. Dyslipidemia was not significantly associated with HIV status, or with HIV-specific factors. Older age, being overweight, abdominal obesity, and low fruit and vegetable intake were associated with dyslipidemia and may be targets for public health interventions to lower the prevalence of dyslipidemia and CVD risk in sub-Saharan Africa.
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Affiliation(s)
| | - Sarah J. Masyuko
- Department of Global Health, University of Washington, Seattle, WA
- Ministry of Health
| | | | - Tecla Temu
- Department of Global Health, University of Washington, Seattle, WA
| | - John Kinuthia
- Kenyatta National Hospital
- University of Nairobi, Nairobi, Kenya
| | - Alfred O. Osoti
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Carey Farquhar
- Departments of Global Health, Medicine and Epidemiology, University of Washington
| | - Stephanie T. Page
- Department of Medicine, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA
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Temu TM, Zifodya JS, Polyak SJ, Wagoner J, Wanjalla CN, Masyuko S, Nyabiage J, Kinuthia J, Bloomfield GS, Page ST, Farquhar C. Antiretroviral therapy reduces but does not normalize immune and vascular inflammatory markers in adults with chronic HIV infection in Kenya. AIDS 2021; 35:45-51. [PMID: 33055570 PMCID: PMC7718419 DOI: 10.1097/qad.0000000000002729] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Markers of monocyte/macrophage activation and vascular inflammation are associated with HIV-related cardiovascular diseases (CVD) and mortality. We compared these markers among African people living with HIV (PLWH) and HIV-negative adults, and examined risk factors associated with elevated biomarkers (>75th percentile) in PLWH on antiretroviral therapy (ART). DESIGN Cross-sectional study. METHODS We measured serum concentrations of a gut integrity biomarker (intestinal-fatty acid binding protein), monocyte/macrophage activation biomarkers (soluble CD14 and CD163), and vascular inflammation biomarkers [soluble intercellular adhesion molecule 1 (sICAM-1) and soluble vascular adhesion molecule 1 (sVCAM-1)]. We assessed the relationship of these inflammatory parameters with HIV, using logistic regression adjusting for traditional CVD risk factors. RESULTS Among the 541 participants, median age was 43 years and half were female. Among 275 PLWH, median CD4 T-cell count and duration of ART use was 509 cells/μl and 8 years, respectively. PLWH had significantly higher prevalence of elevated inflammatory biomarkers compared with HIV-negative individuals even after adjustment for traditional CVD risk factors. Compared with individuals without HIV, the prevalence of elevated biomarkers was highest among persons with detectable viral load and CD4 T-cell counts 200 cells/μl or less. In a subanalysis among PLWH, nadir CD4 T-cell count 200 cells/μl or less was associated with elevated soluble CD14 (sCD14); dyslipidemia with elevated sCD14, sICAM-1, and sVCAM-1; and overweight/obesity with reduced sCD14. Longer ART exposure (>4 years) was associated with reduced sVCAM-1 and sICAM-1. CONCLUSION HIV and not traditional CVD risk factors is a primary contributor of monocyte/macrophage activation and inflammation despite ART. Anti-inflammatory therapies in addition to ART may be necessary to reduce these immune dysregulations and improve health outcomes of African PLWH.
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Affiliation(s)
- Tecla M Temu
- Department of Global Health, University of Washington, Seattle, Washington
| | - Jerry S Zifodya
- Department of Medicine, Tulane University, New Orleans, Louisiana
| | - Stephen J Polyak
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Jessica Wagoner
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | | | - Sarah Masyuko
- Department of Global Health, University of Washington, Seattle, Washington
- Ministry of Health
- Kenyatta National Hospital, Nairobi, Kenya
| | - Jerusha Nyabiage
- Department of Global Health, University of Washington, Seattle, Washington
| | | | - Gerald S Bloomfield
- Department of Medicine and Duke Global Health Institute, Duke University, Durham, North Carolina
| | | | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Medicine
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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Vargas-Pacherrez D, Cotrim HP, Pires L, Cunha V, Coelho V, Brites C, Daltro C. Metabolic Syndrome in HIV-patients in Antiretroviral Therapy. Curr HIV Res 2020; 18:388-395. [PMID: 32516101 DOI: 10.2174/1570162x18666200609115615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/29/2020] [Accepted: 05/20/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The global prevalence of metabolic syndrome (MS) among people living with HIV/AIDS varies from 20% to 33%. OBJECTIVE to estimate the prevalence of metabolic syndrome and associated factors in a group of HIV-infected patients on antiretroviral therapy. METHODS This is a cross-sectional study with HIV-infected patients from a reference center in Bahia, Brazil. We evaluated clinical, socio-demographic and anthropometric data. MS was defined according to the guidelines of International Diabetes Federation. RESULTS We evaluated 152 patients with mean age of 47.3±11.6 years, 59.2% male. The main comorbidities detected were diabetes (3.3%) hypertriglyceridemia (9.3%) and metabolic syndrome (MS,38.2%). Patients with MS were predominantly women (55.2% vs 31.9%; p=0.005), older [52.1 (10.4) vs 44.3 (11.3); p<0.001], and had overweight (74.1% vs 23.4%; p<0.001). After multivariate analysis MS remained associated with age (OR = 1.076; 95% CI: 1.030 - 1.125), female sex (OR = 2.452; 95% CI: 1.114 - 5.374) and family history of hypertension (OR = 3.678; 95% CI: 1.431 - 9.395). CONCLUSION Almost half of the HIV-infected patients in Bahia presents with MS which seems to be driven by classical risk factors.
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Affiliation(s)
- Daniel Vargas-Pacherrez
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil,Communicable Diseases and Environmental - Pan American Health Organization, Altamira - Caracas 1060, Venezuela
| | - Helma P Cotrim
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Leonardo Pires
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Vitor Cunha
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Vitor Coelho
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Carlos Brites
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil,CoBraH Study Group - Universidade Federal da Bahia (UFBA), Bahia, Brazil
| | - Carla Daltro
- LAPI, Laboratório de Pesquisa em Infectologia. Complexo Hospitalar Professor Edgard Santos, Faculdade de Medicina da Bahia - Universidade Federal da Bahia (UFBA), Bahia, Brazil,Escola de Nutrição - Universidade Federal da Bahia (UFBA), Bahia, Brazil
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17
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Bune GT, Yalew AW, Kumie A. Predictors of Metabolic Syndrome Among People Living with HIV in Gedeo-Zone, Southern-Ethiopia: A Case-Control Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:535-549. [PMID: 33116916 PMCID: PMC7547778 DOI: 10.2147/hiv.s275283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/10/2020] [Indexed: 12/29/2022]
Abstract
Background Intensive access to antiretroviral therapy improved the prognosis of HIV. As a result, a non-communicable disease risk marker known as metabolic syndrome (MS) has emerged. It is a public health issue in sub-Saharan Africa including Ethiopia. However, there is little literature on predictors of MS among people living with HIV (PLHIVs) in the study area context. Purpose To identify predictors of metabolic syndrome among PLHIVs, Gedeo Zone, Southern-Ethiopia. Methods Health institutions-based unmatched case–control study was conducted. All HIV-infected adult persons who are receiving routine care in the randomly selected two hospitals and two health centers of the Gedeo zone, southern Ethiopia were involved in the study, conducted from December 29th, 2017, to January 22nd, 2019. PLHIVs diagnosed with MS using ATP III criteria were considered as a case, and subjects free of MS in the survey were enrolled as controls. Binary logistic regression was employed to identify predictors of MS. Results A total of 633 (139 cases and 494 controls) PLHIVs were included in the study. The multivariable analysis result found that age (AOR=1.09, 95% CI (1.05–1.12)); educational status being completed secondary school (AOR=0.22, 95% CI (0.02–0.42)); occupational status being of students (AOR=0.11, 95% CI (0.24–0.51)); wealth index being in the middle quintile (AOR=0.22, 95% CI (0.06–0.79)); ART status exposed to ART (AOR=3.07, 95% CI (1.37–6.89)); total physical activity state being physically active (AOR=0.36, 95% CI (0.16–0.79)), and engaged in low levels physical activity (AOR=3.83, 95% CI (1.46–10.05)) were the factors significantly associated with MS. Conclusion While education, occupation, wealth index, antiretroviral therapy status, total physical activity, and lower physical activity levels were concluded by the study as modifiable predictors of metabolic syndrome, age was found as a non-modifiable independent risk of metabolic syndrome. There is a need for an ongoing effort to realize an integrated care plan that addresses both the routine care and regular screening programs to reduce the risks associated with MS and its traits in these subjects.
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Affiliation(s)
| | | | - Abera Kumie
- Schools of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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18
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Masenga SK, Elijovich F, Koethe JR, Hamooya BM, Heimburger DC, Munsaka SM, Laffer CL, Kirabo A. Hypertension and Metabolic Syndrome in Persons with HIV. Curr Hypertens Rep 2020; 22:78. [PMID: 32880756 PMCID: PMC7467859 DOI: 10.1007/s11906-020-01089-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW With the advent of highly active antiretroviral therapy (ART), the life span of persons with HIV (PWH) has been nearly normalized. With aging, prevalence of the metabolic syndrome (MetS), including hypertension, has increased in the HIV population and exceeds that in the general population in some studies. This is due to a combination of traditional risk factors in addition to the effects attributable to the virus and ART. We review recent findings on the mechanisms contributing to MetS and hypertension in PWH, particularly those specific to the viral infection and to ART. RECENT FINDINGS Activation of the renin-angiotensin-aldosterone system (RAAS) and chronic immune activation contribute to the development of MetS and hypertension in PWH. HIV proteins and some ART agents alter adipocyte health contributing to dyslipidemias, weight gain, and insulin resistance. HIV infection also contributes to hypertension by direct effects on the RAAS that intertwine with inflammation by the RAAS also contributing to T cell activation. Recent data suggest that in addition to current ART, therapeutic targeting of the MetS and hypertension in PWH, by interfering with the RAAS, treating insulin resistance directly or by use of immunomodulators that dampen inflammation, may be critical for preventing or treating these risk factors and to improve overall cardiovascular complications in the HIV-infected aging population.
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Affiliation(s)
- Sepiso K Masenga
- HAND Research group, School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Fernando Elijovich
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John R Koethe
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benson M Hamooya
- HAND Research group, School of Medicine and Health Sciences, Mulungushi University, Livingstone, Zambia
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Douglas C Heimburger
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Sody M Munsaka
- Department of Biomedical Sciences, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Cheryl L Laffer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Annet Kirabo
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Room 536 Robinson Research Building, Nashville, TN, 37232-6602, USA.
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19
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Masyuko SJ, Page ST, Kinuthia J, Osoti AO, Polyak SJ, Otieno FC, Kibachio JM, Mogaka JN, Temu TM, Zifodya JS, Otedo A, Nakanjako D, Hughes JP, Farquhar C. Metabolic syndrome and 10-year cardiovascular risk among HIV-positive and HIV-negative adults: A cross-sectional study. Medicine (Baltimore) 2020; 99:e20845. [PMID: 32629671 PMCID: PMC7337552 DOI: 10.1097/md.0000000000020845] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To determine the prevalence and correlates of metabolic syndrome (MetS) and compare 10-year cardiovascular disease (CVD) risk among Kenyan adults with and without HIV infection.We conducted a cross-sectional study among adults ≥30 years of age with and without HIV infection seeking care at Kisumu County Hospital. Participants completed a health questionnaire and vital signs, anthropomorphic measurements, and fasting blood were obtained. MetS was defined using 2009 Consensus Criteria and 10-year Atherosclerotic CVD (ASCVD) risk score was calculated. Chi-square, independent t tests, Wilcoxon ranksum test and multivariable logistic regression were used to determine differences and associations between HIV and MetS, CVD risk factors and ASCVD risk score.A total of 300 people living with HIV (PLWHIV) and 298 HIV-negative participants with median age 44 years enrolled, 50% of whom were female. The prevalence of MetS was 8.9% overall, but lower among PLWHIV than HIV-negative participants (6.3% vs 11.6%, respectively; P = .001). The most prevalent MetS components were elevated blood pressure, decreased high density lipoprotein, and abdominal obesity. Adjusting for covariates, PLWHIV were 66% less likely to have MetS compared to HIV-negative participants (adjusted odds ratio [aOR] 0.34; 95% confidence interval [95%CI] 0.18, 0.65; P = .005). Median ASCVD risk score was also lower among PLWHIV compared to HIV-negative participants (1.7% vs 3.0%, P = .002).MetS was more common among HIV-negative than HIV-positive adults, and HIV-negative adults were at greater risk for CVD compared to PLWHIV. These data support integration of routine CVD screening and management into health programs in resource-limited settings, regardless of HIV status.
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Affiliation(s)
| | - Stephanie T. Page
- Department of Global Health
- Department of Medicine, University of Washington, Seattle, WA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital
| | - Alfred O. Osoti
- Department of Global Health
- Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
| | - Stephen J. Polyak
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | - Fredrick C. Otieno
- Department of Clinical Medicine and Therapeutics, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | | | | | | | | | | | - Damalie Nakanjako
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Carey Farquhar
- Department of Global Health
- Department of Medicine, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
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20
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Ergin HE, Inga EE, Maung TZ, Javed M, Khan S. HIV, Antiretroviral Therapy and Metabolic Alterations: A Review. Cureus 2020; 12:e8059. [PMID: 32537277 PMCID: PMC7286589 DOI: 10.7759/cureus.8059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
The introduction of antiretroviral therapy (ART) has caused some metabolic problems to people who suffer from HIV. ART probably is not the sole reason for these metabolic disorders. Most likely, HIV itself affects the metabolism as well. We conducted research to find the prevalence of the different types of metabolic disorders among HIV(+) patients. Female gender, high BMI, and older age are among the risk factors for the occurrence of metabolic disorders. Regarding dyslipidemia, hypertriglyceridemia and low high-density lipoproteins (HDLs) are the most common types of dyslipidemia in the studies we included. Protease inhibitors (PIs) are widely known as the most common class of antiretroviral drugs that cause metabolic disorders, and some studies in our review also demonstrated this knowledge. In our review, we concluded that HIV and ART concurrently alter the metabolism, but further research is required about this substantial topic.
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Affiliation(s)
- Huseyin Ekin Ergin
- Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Evelyn E Inga
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Internal Medicine, LaSante Health Center, Brooklyn, USA
| | - Tun Zan Maung
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Mehwish Javed
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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21
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Bune GT, Yalew AW, Kumie A. The extents of metabolic syndrome among Antiretroviral Therapy exposed and ART naïve adult HIV patients in the Gedeo-zone, Southern-Ethiopia: a comparative cross-sectional study. ACTA ACUST UNITED AC 2020; 78:40. [PMID: 32399212 PMCID: PMC7203886 DOI: 10.1186/s13690-020-00420-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 04/14/2020] [Indexed: 12/14/2022]
Abstract
Background HIV infection and Antiretroviral Therapy (ART) has been associated with metabolic syndrome (MS). The prevalence of MS varies substantially between populations and is not yet well-known in sub-Saharan Africa (SSA), including Ethiopia. The current study aims to estimate and evaluate the magnitude of MS among ART exposed and ART naïve HIV-infected patients. Methods A comparative cross-sectional design was employed among the randomly chosen PLHIVs from two hospitals and two health centers, found in the Gedeo zone, southern-Ethiopia. Data collection was run beginning from December 29th, 2017 up to January 22nd − 2019, using the WHO steep tool; eventually, the completed data entered into Epidata (V-3.1) and exported to SPSS (V− 22) for analysis. The revised international diabetes federation criterion was used to define MS and its components. The mean, standard deviations and proportions were used as a descriptive summary. Categorical data and the proportion of MS in the two groups were compared using binary logistic regression, and results were reported statistically significant with p-value is less than 5%. Results A total of 633 (n = 422 on ART and n = 211 ART-naive) PLHIVS was involved, with an overall response rate of 96.2%. The cumulative proportion of MS was 42.5%(95% CI: 39.2–45.7), with 43.4%(95% CI: 39.1–47.4) among ART exposed and 40.8% (95% CI: 35.5–46.0) among ART naïve patients (P > 0.005). However, the difference was not statistically significant and signified that ART has no association with an increased proportion of MS. Conclusion Overall this study demonstrated the presence of an elevated degree of overall MS among PLHIVs. Besides, although the difference was not statistically significant, a relatively higher proportion of MS was realized in the ART exposed than ART naïve groups. Implicated that at the time of the entire test and treatment approaches employed in this target group, routine screening of MS incorporated through HIV care and management system will be a vibrant action.
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Affiliation(s)
| | | | - Abera Kumie
- 2Schools of Public Health, Addis Ababa University/AAU, Addis Ababa, Ethiopia
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22
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Bune GT, Yalew AW, Kumie A. The global magnitude of metabolic syndrome among antiretroviral therapy (ART) exposed and ART-naïve adult HIV-infected patients in gedio-zone, southern Ethiopia: Comparative cross-sectional study, using the Adult Treatment Panel III criteria. Diabetes Metab Syndr 2019; 13:2833-2841. [PMID: 31425944 DOI: 10.1016/j.dsx.2019.07.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/29/2019] [Indexed: 02/07/2023]
Abstract
AIM The global operation of antiretroviral therapy (ART) has averted 30 million new infections and nearly 8 million deaths; however, it has an impact on metabolic syndrome (MS) acquisition. As a result, there is growing concern about MS; but strangely the magnitude of MS in HIV-infected cohort, and its differential contribution ART status in Ethiopia has yet to be abundantly studied. Hence, the aim of this study was to estimate and evaluate the difference of the overall magnitude of MS among ART exposed and ART naïve people living with HIV (PLWH). MATERIALS AND METHODS An institution based cross-sectional study was conducted at the randomly chosen two hospitals and health centers, in Gedio zone, southern Ethiopia between December 29th, 2017 and January 22nd, 2019. Data were collected using the WHO three step tools. The collected data were fed into Epidata version.3.1 and exported to SPSS version 22 for analysis. The descriptive complex sample analysis method was employed, and the prevalence and differences between groups were computed with a 95% CI. RESULT A total of 633 (n = 422 ART and n = 211 ART naive) PLWH was involved, with the response rate of 92.1%. Of whom, 22.0% (95% CI: 19.0-25.4) of PLWH had MS. It was slightly higher in the ART-exposed (22.5%, 95% CI: 18.7-26.8) than ART naïve (20.9%, 95% CI: 15.2-27.1) group. CONCLUSION The global magnitude of MS in the ART-exposed was relatively higher than ART naïve groups. This dictates the existence of HIV associated MS that necessitates immediate prevention and management strategies.
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Affiliation(s)
| | | | - Abera Kumie
- Schools of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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23
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Reid MJ, Ma Y, Golovaty I, Okello S, Sentongo R, Feng M, Tsai AC, Kakuhikire B, Tracy R, Hunt PW, Siedner M, Tien PC. Association of Gut Intestinal Integrity and Inflammation with Insulin Resistance in Adults Living with HIV in Uganda. AIDS Patient Care STDS 2019; 33:299-307. [PMID: 31188016 DOI: 10.1089/apc.2019.0032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We conducted a cross-sectional study of 148 HIV+ on HIV antiretroviral therapy and 149 HIV- adults in Mbarara, Uganda, to estimate the association between HIV infection and homeostasis model assessment of insulin resistance (HOMA-IR) using multivariable regression analysis. In addition, we evaluated whether intestinal fatty acid-binding protein (I-FABP), monocyte activation markers soluble (s)CD14 and sCD163, and proinflammatory cytokine interleukin 6 (IL-6) mediated this association. HOMA-IR was greater among HIV+ than HIV- adults [median (interquartile range): 1.3 (0.7-2.5) vs. 0.9 (0.5-2.4); p = 0.008]. In models adjusted for sociodemographic variables, diet, hypertension, and smoking history, HIV infection was associated with 37% [95% confidence intervals (95% CIs): 5-77] greater HOMA-IR compared with HIV- participants. The magnitude of association was greater when I-FABP was included as a covariate although the additive effect was modest (40% CI: 8-82). By contrast adding sCD14 to the model was associated with greater HOMA-IR (59%; 95% CI: 21-109) among HIV+ participants compared with HIV- participants. Among HIV+ participants, greater CD4 nadir was non-significantly associated with greater HOMA-IR (22%; 95% CI: -2 to 52). Each 5-unit increase in body mass index (BMI; 49% greater HOMA-IR; 95% CI: 18-87) and female sex (71%; 95% CI: 17-150) remained associated in adjusted models. In this study of mainly normal-weight Ugandan adults, HIV infection, female sex, and greater BMI were all associated with greater insulin resistance (IR). This association was strengthened modestly after adjustment for sCD14, suggesting possible distinct immune pathways to IR that are independent of HIV or related to inflammatory changes occurring on HIV treatment.
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Affiliation(s)
- Michael J.A. Reid
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Yifei Ma
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Iya Golovaty
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Samson Okello
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ruth Sentongo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Maggie Feng
- Massachusetts General Hospital, Boston, Massachusetts
| | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | | | | | - Peter W. Hunt
- Department of Medicine, University of California, San Francisco, San Francisco, California
- Department of Experimental Medicine, University of California, San Francisco, San Francisco, California
| | - Mark Siedner
- Mbarara University of Science and Technology, Mbarara, Uganda
- Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco, San Francisco, California
- Medical Service, Department of Veteran Affairs Medical Center, San Francisco, California
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